Teaching hospitals across the country are working to build stronger support systems for physicians in training and do away with long-standing perceptions of residency as a relentless, isolating experience.
Increased intentionality and focus on resident well-being comes at a critical time. In recent years, a growing number of residents have sought unionization. At least five groups of residents and fellows have unionized at their health systems so far this year.
“Physician unionization has massively increased since 2020, especially among interns and residents,” Rebecca Givan, PhD, associate professor of labor studies and employment relations at Rutgers University in New Brunswick, N.J., told Becker’s earlier this year. “This reflects the specific strains put on healthcare workers during the pandemic and the widespread interest in unionization among young professional workers across numerous industries.”
Meanwhile, a JAMA Network study published in May found suicide was the leading cause of death among U.S. residents and fellows between 2015 and 2021. While the rate was lower than that among the general population, the findings point to the need for greater access to mental health services and institutional-level support.
Leaders at four teaching hospitals across the country told Becker’s they have expanded access to mental health resources, set up stronger feedback mechanisms and in some cases, made structural program changes to better support resident satisfaction and well-being in recent years.
More recent data suggest that, collectively, these efforts are driving improvements in measures of resident wellness and job satisfaction. In 2024, residents reported increases in job satisfaction and lower burnout rates than in 2023, according to the AMA’s annual “National Resident Comparison Report.”
Turning feedback into action
Understanding the unique challenges residents are facing and taking meaningful action starts with having strong feedback mechanisms in place, leaders said. An institutional commitment to soliciting and acting on feedback is central to creating a culture where well-being is infused into daily operations, as opposed to approaching wellness through ad hoc resources.
“We have taken the approach of trying to make sure, for an extended period of time, that the resident and fellow voices are heard, and that we then respond and communicate back on ‘This is what we heard. And here’s what we’ve done,'” said Donald Yealy, MD, chief medical officer and senior vice president of the health services division at Pittsburgh-based UPMC Health, which operates the nation’s fourth largest residency training program.
“That, by itself, goes a long way,” he said. “When you hear of residents and fellows organizing in some other matter, it almost always comes from a place of, ‘I think we’re not heard, and therefore our needs aren’t really addressed.'”
Soliciting feedback should be a routine part of operations, with both formal and informal structures that enable residents to share transparent insights in the ways they feel most comfortable with, leaders said. Annual surveys shouldn’t be overlooked either, leaders added, describing them as a reliable means of gauging how resident needs are changing and what new types of support they’re craving.
Rebecca Blankenburg, MD, associate dean of GME at Stanford (Calif.) Medicine said
insights gleaned from the Accreditation Council for Graduate Medical Education’s annual survey of residents and fellows helped the academic health system determine four key areas of focus to support resident well-being: Improving access to mental health, addressing mistreatment from patients and staff, expanding resources for trainees who are parents and building community.
“We’ve found it really helpful to look at the open-ended comments,” she said. “Each year, we get about 700 open-ended comments on our resident and fellow surveys. Those have been some of the best in terms of giving us a sense of what is working, what isn’t working and how we can further improve.”
At Portland, Ore.-based Legacy Health, the most formal feedback mechanism is a resident program evaluation committee, said Karen Weiss, DO, clinical vice president of medical education at the system. The group includes a handful of residents per class who convene several times a year to discuss questions or concerns. Leaders also approach the group when faced with decisions about new resources or changes to program structure to involve residents and secure buy-in.
“Even if there’s only two options that could work as a solution, if the residents are the ones who get to vote and choose which of those two options you move forward with, you’re going to have a lot more support for whatever the change is,” Dr. Weiss said. “Change is always hard, but if they’re part of those discussions and feel heard, things just go more smoothly.”
One of the most significant changes to Legacy Health’s residency program structure was the creation of a swing shift to better manage patient hand-offs when clinicians come in for night shifts — an idea driven entirely by the evaluation committee.
Residents expressed how they were finding it challenging to get a formal hand off where they’re able to adequately assess ICU patients they’d be covering overnight because they were also managing new admissions from the ED. Their desired solution was to create a shift from 6 p.m. to midnight where a resident’s sole duty is to manage admissions from the ED and respond to code blues.
“They can admit a total of four patients and it offloads those night teams so when they’re coming on, they’re protected and able to get an official handoff,” Dr. Weiss said. “They’re able to round through the ICU, get to know the patients they’re going to be cross-covering for the night and know they’re not going to get a call for an admission.”
Residents shared overwhelmingly positive feedback on the swing shift, which is now in place at two of the system’s hospitals. The adjustment is one acknowledgment of what residents have identified as a major source of stress: scheduling. In the AMA’s 2024 report, 26% of respondents pointed to schedule-related concerns as a key job-related stressor in written comments.
At UPMC Health, having leaders connect with residents on a regular basis has been valuable in being able to solve shared challenges quickly after they arise, according to Gregory Bump, MD, associate dean for graduate medical education.
“What I see are very personal issues people are experiencing and they feel burnout when they don’t feel that they have the resources to address it,” Dr. Bump said. “We’ve been trying to put leadership together with frontline workers more often to hear these concerns and react to them, because honestly, once leadership hears about it, they’re usually straightforward to fix it.”
Over the past few years, residents have raised several issues that have been relatively simple to fix once on leaders’ radar, he said. Refreshing menu options in the cafeteria after residents raised concerns about dietary restrictions, and purchasing a dedicated freezer where new moms can store breast milk are two examples of minor fixes that have had an outsized effect in building trust by ensuring resident needs are both heard and addressed.
Expanding mental health services
Each of the leaders Becker’s spoke to said their institutions have expanded access to mental health resources for trainees in recent years, driven by increased demand.
“These are things that trainees, even five years ago, did not ask for or even know that they wanted or needed,” said Peter Rhee, DO, assistant dean of trainee well-being at the Mayo Clinic School of Graduate Medical Education in Rochester, Minn. “This shift illustrates the normalization of mental health challenges amongst trainees and their peers.”
Mayo Clinic has increased access to mental health counselors, which residents can access through a GME well-being website — a one-stop shop that compiles a trove of resources to support wellness.
Sanford Medicine and Legacy Health have also embedded platforms to connect trainees with mental health care services. At Legacy, all trainees have free access to Tend Health, a confidential telehealth service that offers counseling, performance coaching, communication and test-taking strategies. Around 75% of trainees have used the service, Dr Weiss said. She linked high utilization to the ability for residents to access virtual appointments quickly, including on evenings and weekends.
Similarly, Stanford Medicine provides trainees with round-the-clock access to free mental health resources, which 30% of residents and fellows currently use, Dr. Blankenburg said.
UPMC educates all new employees on the mental health benefits it offers. Dr. Bump said leaders are intentional in modeling openness and vulnerability when communicating with trainees about these resources to maintain a culture of acceptance and awareness around mental health.
“What I’m very intentional to say is, ‘This may apply to you. It may not. If you don’t feel like this applies to you, I want you to pay attention to it, because it will apply to one of your peers,'” Dr. Bump said. “We really need to foster a culture where we are our brother’s helper. Educating folks that this is important for them, but also important for their colleagues, is super helpful in disseminating this information.”
Several years ago, UPMC started an interactive screening program in partnership the American Foundation for Suicide Prevention, where all residents and fellows receive an invitation to complete an anonymous survey twice per year. The AFSP evaluates results from respondents, placing them into tiered risk groups based on distress levels. Residents identified as being in distress receive an invitation to partner with UPMC’s Employee Assistance program and be connected to relevant resources. During the first two years of implementation, 98% of the 200 trainees who participated in the screening program experienced at least a moderate level of distress.
The health system has since expanded the program to all faculty.
“It’s been a very useful tool to find people who are really suffering in silence; who maybe don’t know about our usual mechanisms to connect with care and get them the help they need,” Dr. Bump said.
What leaders described is not merely an addition of services, but rather a broader effort to embed well-being into the academic training pathway and institutional culture. That shift, leaders say, is what distinguishes lasting change from isolated efforts.
“It’s just been such a foundation of who we are as a program rather than the buzzword wellness,” Dr. Weiss said. “Just making sure residents are doing well and are happy because the happier they are the less likely they are to call in sick. It really goes hand-in-hand.”
